Dry Eye

Tearing, Dry Eye, and Eyelid Inflammation

Comfortable eyes and good vision require healthy lids, normal blinking, normal tear production and drainage, and avoidance of situations which irritate our eyes.

Tearing and eyelid inflammation are very common problems for patients. We specialize in treating these problems. First, a basic understanding of tear physiology is helpful. How the eye lubricates and protects itself is a complex process. We make and drain tears (drainage covered in plastic surgery section). Any imbalance between production and drainage can result in excessive tearing. Poor eyelid health contributes to irritation and extra tearing as well.

Our tear film is actually a “sandwich” of a mucoid layer, liquid tears, and a fatty layer. Problems with the mucoid layer are rare. The liquid or tears are made by lacrimal glands: any problem with this is called dry eye syndrome. The fatty layer of the tear film is produced by the eyelid glands called the Meibomian glands: each time we blink we sweep this oily layer over our eyes to reduce tear evaporation. A problem with these oil glands is called blepharitis or Meibomian gland dysfunction (MGD).

Dry eye or keratitis sicca is one of the most troublesome eye problems. It is a problem caused by deficient tearing. This problem is worsened by wind, bright sun, and low humidity so dry eye patients often feel worse at the desert, in mountains, on planes or on windy days. When we concentrate, our blink rate goes down so often dry eyes are worse when driving, reading or using the computer. People complain of itching, pain, blurred vision, red eyes, and paradoxically excess tearing. Excess tearing in dry eye is reflex tearing because the eye is irritated. Treatment is frequent lubrication with artificial tears, lubricating gel, ointment, vitamins, and prescription drops.

Often the drainage system may be plugged to minimize tear drainage so what tears the patient makes stay over the eye surface longer.

Tear plugs above

MGD or blepharitis

Many people have oil glands that are blocked or backed up. This stagnation causes irritation of the eyelids and permit the infestation of eyelid mites. This lid irritation in turn irritates the eyes. Blockage of the oil glands also reduces the oil production necessary to cut down on tear evaporation. Often this condition presents red, irritated eyelids.

Treatment includes heat to the lids, massaging the oil glands and cleansing the lids. This is done at home and must be consistently done by the patient. Home care is often supplemented by office treatments which more aggressively clean and treat the eyelids. One treatment, called Blephex, mechanically polishes the lid margins to the lids to remove dead skin, and excess dried secretions. OCuSOFT (Thermal One Touch) are heat treatments are in office treatments which soften and remove thick oil blocking your lid oil glands. These two treatments are often quite helpful supplementing at home treatments. Medications are also helpful.


There is no “cure” for dry eye or lid margin diseases. As with other problems with our health they can be controlled with consistent care. The problem may require several approached to control the irritation and tearing.

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